The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.
Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.
Attia J, Kelly B, Best M.
Abstract:
In Ancient Greece, when treating patients whose condition was incurable, physicians would sometimes use poisons and other techniques, hastening death in order to relieve suffering. The Hippocratic Oath was revolutionary in its time, going against such practices by swearing to “neither give a deadly drug to anybody if asked for it, nor making a suggestion to this effect.” While this has been a foundational text of western medical ethics for over 2000 years, Voluntary Assisted Dying (VAD) has shaken this foundation.
As physicians in Palliative Care, Psychiatry, and Bioethics, we have noticed that many of our colleagues feel ill-equipped to have discussions with patients surrounding VAD; while the pros of VAD are familiar from popular media, the cons are much less so. We believe that doctors need to understand both sides of the argument in order to have balanced and informed discussions with their patients. In this spirit, we offer a reflection on what we have found to be common assumptions when discussing VAD (see summary in Table 1). By necessity, this means exploring the moral and religious perspectives that underpin our medical practice.
Brooksbank MA.
Abstract: This is a shortened version of the personal reflections of the early developments of palliative care in Adelaide, South Australia delivered as the Rosalie Shaw Oration at the Australia and New Zealand Society of Palliative Medicine conference, Adelaide 6 September 2024: 30 years of palliative medicine: constructing, challenging and transforming.
Cooper AL, Martin-Robins D, Panizza N, Coppock S, Brown JA.
Aim: To gain an understanding of palliative care need and provision in adult medical and surgical inpatients.
Design: An observational point prevalence study was conducted across four study sites in Western Australia.
Methods: All data were collected directly from patient medical records by Registered Nurses. Potential palliative care need was assessed using disease-specific indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indicator Guidance.
Results: A total of 865 medical and surgical inpatients met study inclusion criteria. Across the four study sites, 38% (n = 331) of adult inpatients reviewed could have potentially benefitted from palliative care. Of the n = 331 patients assessed as having indicators for palliative care, there was evidence that 27% (n = 90) were currently receiving some form of palliative care, while 3% (n = 9) had been referred for specialist palliative care. For the majority of patients (70%, n = 232) there was no evidence of them receiving any form of palliative care or awaiting specialist palliative care.
Conclusion: This study identified high levels of potential palliative care need among adult medical and surgical inpatients. The majority of the patients identified as having indicators for palliative care were not receiving any form of palliative care.
Implications for the profession and/ or patient care: The high prevalence of palliative care need found in this study highlights that recognising and addressing palliative care is essential for high-quality care for medical and surgical inpatients. To address the high level of need identified all nurses require basic palliative care training to provide optimal patient care.
Impact: Knowledge about the level of palliative care need and provision of palliative care in public hospitals was limited. This study identified a high prevalence of potential palliative care need in medical and surgical inpatients. The majority of patients with indicators for palliative care were not receiving any form of palliative care. This research demonstrates that palliative care needs should be considered by all registered nurses and other health professionals caring for medical and surgical inpatients.
Razmovski-Naumovski V, Martin JH, Chye R, Phillips JL, Lintzeris N, Solowij N, et al.
Context: Evaluating medicinal cannabis in clinical trials is important for informing its efficacy and safety in clinical care. Alongside the inherent practical challenges of conducting clinical trials in people receiving palliative care, operationalizing clinical trials with a medicinal cannabis product requires additional consideration of legal, regulatory, ethical, feasibility, pharmacological and product requirements.
Objectives: This manuscript aims to explore these considerations when operationalizing medicinal cannabis clinical trials in people receiving palliative care.
Methods: Our Phase I/IIb trial examined pharmacokinetic, toxicity and secondary (efficacy) outcomes of a vaporized medicinal cannabis product for anorexia in people with advanced cancer (ACTRN12616000516482). Using action research methodology, notes from trial investigator meetings served as an audit trail for the planning and execution of the trial. These data were integrated and synthesized to reveal key design considerations for operationalizing medicinal cannabis trials evaluating symptom control in people receiving palliative care.
Results: Six key considerations emerged including: 1) Operating within medicinal cannabis legislation; 2) Biological plausibility of cannabinoid type(s) and impact on target symptoms; 3) Standardising cannabinoid content, mode of administration, dosage and packaging; 4) Ethical and safety considerations; 5) Optimizing trial site operationalization; and 6) Pharmacy dispensing, storage and security of product. Learnings and recommendations for future trials are also discussed.
Conclusion: This study explores the learnings and challenges involved in designing and conducting medicinal cannabis trials for symptom management in people receiving palliative care. These insights gained from our experience can inform the optimal design and operationalization of future medicinal cannabis trials in cancer and other chronic conditions.
Sousa MS, Garcia MV, Blanchard M, Daveson B, Currow D, Khan NN, et al.
Purpose: Pancreatic cancer poses significant challenges in symptom management. Many people have intractable pain and anorexia which is often not amenable to current available options for palliation. This study aims to outline the longitudinal patterns and assess the burden of distress related to pain and appetite experienced by individuals with pancreatic cancer in people referred to Australian palliative care services.
Methods: Consecutive national cohort study using point-of-care data on symptom distress in people referred to specialist palliative care services.
Results: From 2013 to 2022, information from 20,558 care episodes involving 15,536 people with pancreatic cancer referred to 203 palliative care services nationally were included. Similar numbers of people were admitted to inpatient and community services, with 69% and 60% reporting distress due to pain and appetite, respectively. Distress extended to sleeping (79%, 82%), nausea (83%, 85%), bowels (80%, 83%), breathing (70%, 77%) and fatigue (77%, 77%) for pain and appetite, respectively. Strongest associations were with psychological/spiritual issues (inpatient OR 1.78, 95% CI 1.66-1.90) and pain severity (community OR 1.51, 95% CI 1.42-1.60) for appetite-related distress and pain severity (inpatient OR 1.60, 95% CI 1.49-1.72; community OR 1.35, 95% CI 1.27-1.44) for pain distress. Trends within the cohort revealed increased mild appetite-related distress (+ 10%) and decreased moderate (- 22%) and severe (- 11%) distress, with similar trends for pain.
Conclusion: This study underscores prevalent distress in people with pancreatic cancer in Australian palliative care, highlighting the need for optimised referrals and strategies targeting pain severity, appetite-related concerns and psychological and spiritual aspects for improved care outcomes.
Last updated 30 April 2024